Scar border zone mass and presence of border zone channels assessed with cardiac magnetic resonance imaging are associated with ventricular arrhythmia in patients with ST-segment elevation myocardial infarction

Abstract

Aims Late gadolinium enhancement cardiac magnetic resonance (CMR) permits characterization of left ventricular ischaemic scars. We aimed to evaluate if scar core mass, border zone (BZ) mass, and BZ channels are risk markers for subsequent ventricular arrhythmia (VA) in ST-segment elevation myocardial infarction (STEMI). Methods and results A sub-study of the DANish Acute Myocardial Infarction-3 multi-centre trial and Danegaptide phase II proof-of-concept clinical trial in which a total of 843 STEMI patients had a 3-month follow-up CMR. Of these, 21 patients subsequently experienced VA during 100 months of follow-up and were randomly matched 1:5 with 105 controls. A VA event was defined as: ventricular tachycardia, ventricular fibrillation, or sudden cardiac death. Ischaemic scar characteristics were automatically detected by specialized software. We included 126 patients with a median left ventricular ejection fraction of 51.0 ± 11.6% in cases with VA vs. 55.5 ± 8.5% in controls (P = 0.10). Cases had a larger mean BZ mass and more often BZ channels compared to controls [BZ mass: 17.2 ± 10.3 g vs. 10.3 ± 6.0 g; P = 0.0002; BZ channels: 17 (80%) vs. 44 (42%); P = 0.001]. A combination of ≥17.2 g BZ mass and the presence of BZ channels was five times more prevalent in cases vs. controls (P ≤ 0.00001) with an odds ratio of 9.40 (95% confidence interval 3.26–27.13; P ≤ 0.0001) for VA. This identified cases with 52% sensitivity and 90% specificity. Conclusion(s) Scar characterization with CMR indicates that a combination of ≥17.2 g BZ mass and the presence of BZ channels had the strongest association with subsequent VA in STEMI patients. ClinicalTrials.gov Unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER), NCT01960933 (DANAMI 3-PRIMULTI), and NCT01977755 (Danegaptide).

Non-revascularized chronic total occlusions impact on substrate and post-ablation results in drug-refractory electrical storm

“…We hypothesize that our observations can be explained by more complex substrate which limits RFCA efficiency, especially in ES acute settings. In the presence of CTOs, scar border-zone (BZ) area is usually expected to be larger and more heterogenous ( 6 ) which strongly correlates with both spontaneous incident VTs ( 17 ) and VT inducibility at PVS ( 18 ). Most myocardial segments which are supplied by NR-CTOs have less than 50% scar transmurality ( 19 ).…”

Texture-based Probability Mapping in cardiac LGE Images: A novel automatic assessment of myocardial injury following revascularized STEMI

“…However, myocardial fibrosis in the non-infarcted territory may have significant clinical consequences and be associated with reduced myocardial function. The peri-infarct zone is a determinant of ventricular arrhythmia 19, 20 . TPM-based assessment may, therefore, potentially be used to assess the risk of arrhythmia.…”

Antiarrhythmic and Anti-Inflammatory Effects of Sacubitril/Valsartan on Post-Myocardial Infarction Scar

“…The mass of the BZ and the amount and mass of BZ corridors have been strongly associated with VA and were reduced in the Sac/Val group. 31,32 In fact, efforts are being made to integrate these variables into prognostic algorithms. [33][34][35] In our study, the observed reductions in BZ mass and corridors in the Sac/Val group could potentially explain the reduction in inducible VT, as animals with inducible VT had greater BZ mass and BZ corridor numbers, regardless of the treatment received.…”